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End of Life Care for Patients Dying of Stroke: A Comparative Registry Study of Stroke and Cancer.

https://arctichealth.org/en/permalink/ahliterature274386
Source
PLoS One. 2016;11(2):e0147694
Publication Type
Article
Date
2016
Author
Heléne Eriksson
Anna Milberg
Katarina Hjelm
Maria Friedrichsen
Source
PLoS One. 2016;11(2):e0147694
Date
2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Communication
Disease Management
Family
Female
Humans
Male
Neoplasms - epidemiology
Odds Ratio
Palliative Care - standards
Prevalence
Quality of Health Care
Registries
Retrospective Studies
Stroke - diagnosis - epidemiology
Sweden - epidemiology
Terminal Care - standards
Abstract
Although stroke is a significant public health challenge and the need for palliative care has been emphasized for these patients, there is limited data on end-of-life care for patients dying from stroke.
To study the end-of-life care during the last week of life for patients who had died of stroke in terms of registered symptom, symptom management, and communication, in comparison with patients who had died of cancer.
This study is a retrospective, comparative registry study.
A retrospective comparative registry study was performed using data from a Swedish national quality register for end-of-life care based on WHO`s definition of Palliative care. Data from 1626 patients who had died of stroke were compared with data from 1626 patients who had died of cancer. Binary logistic analyses were used to calculate odds ratios, with 95% CI.
Compared to patients who was dying of cancer, the patients who was dying of stroke had a significantly higher prevalence of having death rattles registered, but a significantly lower prevalence of, nausea, confusion, dyspnea, anxiety, and pain. In addition, the stroke group had significantly lower odds ratios for health care staff not to know whether all these six symptoms were present or not. Patients who was dying of stroke had significantly lower odds ratio of having informative communication from a physician about the transition to end-of-life care and of their family members being offered bereavement follow-up.
The results indicate on differences in end-of-life care between patients dying of stroke and those dying from cancer. To improve the end-of-life care in clinical practice and ensure it has consistent quality, irrespective of diagnosis, education and implementation of palliative care principles are necessary.
Notes
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PubMed ID
26845149 View in PubMed
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Ethical dilemmas around the dying patient with stroke: a qualitative interview study with team members on stroke units in Sweden.

https://arctichealth.org/en/permalink/ahliterature258547
Source
J Neurosci Nurs. 2014 Jun;46(3):162-70
Publication Type
Article
Date
Jun-2014
Author
Helene Eriksson
Gisela Andersson
Louise Olsson
Anna Milberg
Maria Friedrichsen
Source
J Neurosci Nurs. 2014 Jun;46(3):162-70
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Death
Communication Barriers
Female
Hospice and Palliative Care Nursing - ethics
Humans
Male
Neuroscience Nursing - ethics
Nurses' Aides - ethics - psychology
Nursing Staff, Hospital - ethics - psychology
Nursing, Team - ethics
Palliative Care - ethics
Physical Therapists - ethics - psychology
Qualitative Research
Right to Die - ethics
Stroke - nursing - rehabilitation
Sweden
Terminal Care - ethics
Abstract
In Sweden, individuals affected by severe stroke are treated in specialized stroke units. In these units, patients are attended by a multiprofessional team with a focus on care in the acute phase of stroke, rehabilitation phase, and palliative phase. Caring for patients with such a large variety in condition and symptoms might be an extra challenge for the team. Today, there is a lack of knowledge in team experiences of the dilemmas that appear and the consequences that emerge. Therefore, the purpose of this article was to study ethical dilemmas, different approaches, and what consequences they had among healthcare professionals working with the dying patients with stroke in acute stroke units. Forty-one healthcare professionals working in a stroke team were interviewed either in focus groups or individually. The data were transcribed verbatim and analyzed using content analysis. The ethical dilemmas that appeared were depending on "nondecisions" about palliative care or discontinuation of treatments. The lack of decision made the team members act based on their own individual skills, because of the absence of common communication tools. When a decision was made, the healthcare professionals had "problems holding to the decision." The devised and applied plans could be revalued, which was described as a setback to nondecisions again. The underlying problem and theme was "communication barriers," a consequence related to the absence of common skills and consensus among the value system. This study highlights the importance of palliative care knowledge and skills, even for patients experiencing severe stroke. To make a decision and to hold on to that is a presupposition in creating a credible care plan. However, implementing a common set of values based on palliative care with symptom control and quality of life might minimize the risk of the communication barrier that may arise and increases the ability to create a healthcare that is meaningful and dignified.
PubMed ID
24796473 View in PubMed
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Nurses' conceptions of facilitative strategies of weaning patients from mechanical ventilation--a phenomenographic study.

https://arctichealth.org/en/permalink/ahliterature149013
Source
Intensive Crit Care Nurs. 2009 Oct;25(5):225-32
Publication Type
Article
Date
Oct-2009
Author
Jeanette Eckerblad
Heléne Eriksson
Anita Kärner
Ulla Edéll-Gustafsson
Author Affiliation
Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Sweden.
Source
Intensive Crit Care Nurs. 2009 Oct;25(5):225-32
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Clinical Competence
Cooperative Behavior
Decision Making
Female
Frustration
Health Knowledge, Attitudes, Practice
Humans
Intensive Care - methods
Interprofessional Relations
Intuition
Male
Nurse's Role - psychology
Nursing Assessment - methods
Nursing Methodology Research
Nursing Process
Nursing Staff, Hospital - education - psychology
Professional Autonomy
Qualitative Research
Questionnaires
Sweden
Ventilator Weaning - methods - nursing
Abstract
Mechanical ventilator withdrawal can amount up to 40% of total ventilator time. Being on a mechanical ventilator is associated with risk of anxiety, post-traumatic stress syndrome, nosocomial pneumonia and premature mortality.
The purpose of the present study was to describe different conceptions of nurses' facilitating decision-making strategies regarding weaning patients from mechanical ventilations cared for in intensive care unit (ICU).
Semi-structured interviews were analysed within the phenomenographic framework. Twenty ICU nurses were interviewed.
The findings revealed three main categories of nurses' facilitating decision-making strategies: "The intuitive and interpretative strategy" featured nurses' pre-understandings. "The instrumental strategy" involved analysis and assessment of technological and physiological parameters. "The cooperative strategy" was characterised by interpersonal relationships in the work situation. Absence of a common strategy and lack of understanding of others' strategies were a source of frustration. The main goals were to end mechanical ventilator support, create a sense of security, and avoid further complications.
Although these findings need to be confirmed by further studies we suggest that nurses' variable use of individual strategies more likely complicate an efficient and safe weaning process of the patients from mechanical ventilation.
PubMed ID
19695878 View in PubMed
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